Life expectancy in the U.S. is dropping, and it’s likely due to opioid poisoning. From 2000 to 2015, drug poisoning mortality more than doubled, and mortalities involving opioids reportedly tripled. The reported numbers are likely an underestimate of reality. Regular drug use results in health complication. Deaths caused by these complications are often not properly attributed to drug use. This increase is obvious even when looking at drug overdoses in 2015 and 2016. There were 52,404 reported drug overdoses in 2015, and anywhere from 59,000 to 65,000 drug overdoses in 2016. Even from these numbers, it’s clear that fatal overdoses have increased anywhere from 11% to 24% in the past years. The amount of drug overdoses occurring each year is increasing at alarming rates. Opioid use is becoming a national epidemic. Better education in regards to opioid abuse can help counter this problem. There’s a strong need to improve the public’s understanding of the factors driving this health crisis. The dangers of opioid abuse should also be fully explained.
Common Types of Opioids and Prescription Recommendations
Opioids are specific types of drugs that interfere with certain receptors in the human body to either block or neutralize pain. These drugs are not solely found on the streets. In fact, many of these drugs are prescription painkillers. The World Health Organization (WHO) recommends using different types of these drugs for pain management. The management process includes 3 distinct steps that slowly use increasingly potent drugs. The 3 steps include:
- Acetaminophen, aspirin and other NSAIDs are first recommended for mild to moderate pain. These drugs are not opioids.
- Mild opioids, like codeine or hydrocodone, are administered on an around-the-clock basis if the pain persists or increases.
- Finally, mild opioids are substituted for major opioids, like morphine or hydromorphone, if the pain persists.
This type of pain relief management has an efficiency rate of over 90% when used by terminally-ill patients. Common major opioids prescribed include Oxycodone, Oxymorphone, Fentanyl, Methadone, Dextropropoxyphene, Meperidine, Dilaudid and Dextromethorphan. Each of these drugs use similar biochemical mechanisms to neutralize and block pain.
From Use to Abuse
Although prescription opioids are effective painkillers, they are also highly addictive. Like heroin, these painkillers rapidly flood the body with dopamine and serotonin. Both are neurotransmitters responsible for causing a sense of euphoria and pleasure. Dopamine plays the largest role in addiction. Upon injecting heroin and other opioids, dopamine levels in the brain jump 200% within 8 seconds. This strong sense of euphoria becomes addicting fast. Soon, users begin to crave that sensation on a daily basis. Over time, the body’s ability to naturally produce dopamine and serotonin will decrease due to the artificial stimulation. This increases the need for opioids. The brain will start to crave the drugs to regulate its neurotransmitter levels. Users feel depressed and under the weather without the drug. This results in issues and complication with weaning off of the prescription painkillers. Patients are already reliant and dependent on the drugs. Unfortunately, this can then lead to illegal drug use. In fact, 80% of heroin users start off by misusing prescription opioids.
The Dangers of Using Opioids
As time goes on, the body’s tolerance to the opioid effects increase. This is because the brain adapts to a certain dopamine and serotonin level. It considers the increased levels as normal. As users try to chase the high, larger and larger doses are needed. For illegal drug users, they find themselves quickly treading on thin ice. Their drug addiction becomes more dangerous with time, as the dosage needed to get high is close to the dosage that can cause an overdose. Case in point, the amount of heroin that can cause a fatal overdose is only 5 times as much as the initial amount needed to get high.
The Effects of Imbalanced Dopamine Levels
Constant opioid use causes imbalanced dopamine levels within the body. When dopamine levels are low, physiological responses to the body include:
- feeling fatigued
- poor memory
- depression
- a sense of panic and anxiety
- personality disorders.
Users no longer experience joy and happiness in the same way. The longer that the drugs were being used, the larger the imbalance. The larger the imbalance, the more difficult it becomes to get sober.
The Effects of Imbalanced Serotonin Levels
Memory, learning abilities, sleep patterns and emotions are the first to be affected when manipulating serotonin levels. Low serotonin levels are also often the cause of mood swings, constipation, nausea and confusion. The badly depleted levels of these two neurotransmitters make it hard to get sober. This brain damage can be quite severe. The depleted levels of neurotransmitters can cause long-term brain damage. It can take a long time to recover. Those who become sober may still find it difficult to move forward and heal if their brain chemistry is permanently changed.
Other Effects of Long-Term Opioid Abuse
Opioid abuse does not only affect dopamine and serotonin levels. There are other troubling effects worth mentioning. Long-term opioid abuse can induce:
- immunological effects that increases risks involved with infections
- hormonal changes that cause sexual dysfunction and poor libido
- hyperalgesia, which causes increased pain sensitivity
- sedation, which leads to increased drowsiness
- sleep disturbances by increasing the amount of sleep-waking states experienced
- poor psychomotor performances
- bladder dysfunction involving urinary retention abilities
- cardiac effects like low blood pressure
Different opioids may also come with unique adverse side effects. For example, codeine is often prescribed for postpartum pain. It is even more often prescribed if the mothers had a cesarean section. Codeine can enter the bloodstream and the breast milk. Breastfed infants are at risk of consuming the drugs as well. There have been many instances where the breastfed infants die from symptoms similar to a morphine overdose. In another case, an adverse side effect of hydrocodone abuse is hearing loss. The hearing loss can be so severe that surgery is needed. Hydrocodone abuse can also cause respiratory depression.
The Faces of Opioid Addicts
Many opioid addicts get hooked on the drugs from legitimately prescribed medications. Many patients are unaware of how addictive the drugs prescribed can be. They take the drugs without realizing what the potential consequences are. Due to this reason, the faces of opioid addiction is diverse. The addiction can affect people of every race and at every age. Still, some demographics are more likely to be affected than others. The demographics change from drug to drug. For example, oxycodone addicts tend to be young males who are likely to engage in risky or thrill-seeking behaviors. These individuals also tend to inject or snort their drugs, and have more disposable income. After all, oxycodone is quite expensive. The demographics of the average hydrocodone addict is quite the opposite. These addicts tend to be elderly females who avoid risk. They get their drugs from family, friends and their physicians. When it comes to illegal street drugs, 90% of heroin users are white, and the average age of these addicts is 23. Many addicts hide their addictions well, and are functioning members of society.
Opiate Withdrawal Timeline
When abstaining from taking opioids, users will likely experience withdrawal symptoms. These symptoms are hard to tolerate and overcome. They are often the primary reason for failing to get sober. There are three distinct stages to the opioid withdrawal timeline. The stages include acute, long-term and post-acute withdrawal symptoms. Acute withdrawal symptoms include:
- Insomnia
- Anxiety
- Agitation
- Muscle aches
- Runny nose
- Sweating
The onset and duration time of this stage of withdrawal varies. It mostly depends on the dosage and type of opioids taken. Long-term withdrawal symptoms begin to emerge afterwards. These symptoms overlap with the acute withdrawal symptoms, and are more overbearing. They begin at the peak of the withdrawal and can last for days. Symptoms include irritability, diarrhea and stomach cramps. The onset and duration of both acute and long-term withdrawal symptoms depend on the drug and dosage taken. Different drugs have varying timelines. This is why it’s more successful to detox at a opioid rehab center. The clinicians have a better idea of the expected withdrawal timeline and symptoms. For addicts taking methadone, withdrawal symptoms peak in 72 to 96 hours and can last at least 14 days. For heroin users, withdrawal symptoms peak in 36 to 72 hours and can last for 7 to 10 days. Symptom and withdrawal timelines can also vary if various drugs were used together. Post-acute withdrawal symptoms emerge days to weeks after the physical withdrawal symptoms disappear. This is also known as Post-acute Withdrawal Syndrome (PAWS). It affects approximately 91% of all addicts trying to become sober. These symptoms are more emotional and psychological than physical. They include symptoms like depression, desensitized emotions and sleep disturbances. The effects of these symptoms are the culprits most responsible for relapses.
Opioid Addiction Treatment
To get sober, get professional help from a recovery center. The clinicians will assess each situation to determine the best approach available. It will depend on the drug abused, the duration of the abuse and the amount regularly taken. Most recovery centers recommend a two-step approach. One of the steps involves using medications to wean off of the offending drug. The other step involves using behavioral counseling to prevent relapses. Behavioral counseling is also useful in changing the patient’s mindset.
Medications for Opioid Withdrawals
The most frequently prescribed medications for opioid withdrawals include:
- buprenorphine
- methadone
- extended release naltrexone
Buprenorphine and methadone both have similar abilities in treating withdrawal symptoms. Some studies have noticed that withdrawal symptoms resolve more quickly with buprenorphine. Buprenorphine, methadone and extended release naltrexone all have varying effects on the body. Buprenorphine and methadone both activate the neutrotransmitter receptors. The difference lies in the fact that receptor activation will reach a plateau in buprenorhine. At which point, no additional receptors will be activated even if the dosage increases. Methadone activates more and more receptors as the dosage increases. Naltrexone has a very different chemical effect on the body. It does not stimulate neurotransmitter receptors at all. Due to its mechanisms, buprenorphine has a lower risk of toxicity even at high doses. The withdrawal symptoms also tend to be less severe after discontinuation.
Behavioral Counseling and Therapy
Behavioral counseling improves the patient’s social skills. It also helps them better grasp the methods needed to prevent relapses and setbacks. There are various types of counseling services available. Behavioral counseling looks at the causes behind the addiction. It tries to identify triggers that may cause relapses. Patients then come up with unique approaches to reinforce desirable behaviors. For example, incentives may be set for certain behaviors. Other than behavioral counseling, there are also many other types of therapies. Individual counseling can help patients improve their own mindset. Family counseling can mend broken or strained relationships.
Break the Cycle of Opioid Abuse
If you or someone you know has an opioid addiction, act now. It’s time to tackle the addictions head on for the best results instead of hiding from them. Many recovery centers offer unique programs and tailored treatment plans that help patients get sober. It’s time to acknowledge opioid addiction for what it truly is — an epidemic that desperately needs to be addressed.